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},
"code": "M84.1",
"name": "Несрастание перелома [псевдартроз]",
"icd_name": "Несрастание перелома [псевдартроз]",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0",
"1"
],
"periodicity": 1,
"slug": "m84.1_nesrastanie_pereloma_psevdartroz",
"lead": "патологическое состояние, при котором на месте повреждения не образуется полноценная костная мозоль",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В 90% случаев основным этиофактором несрастающихся переломов становятся локальные нарушения в зоне поражения. На долю системных и общих причин приходится около 5% случаев, у остальных больных различные механизмы сочетаются между собой или остаются неустановленными. Перечень местных факторов включает:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тяжелые повреждения. Чем больше разрушается кость и мягкие ткани, тем обширнее очаги некроза и тем меньше клеток участвует в процессе восстановления. Из-за взаимного отягощения сращение ухудшается при множественных переломах соседних сегментов, одновременном воздействии различных повреждающих факторов (например, при сочетании с отморожением или ожогом).</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Потеря отломков и интерпозиция. Утрата фрагментов при открытых повреждениях или их неоправданное удаление в ходе ПХО приводят к уменьшению площади контакта костной ткани. При развороте отломка, попадании мягких тканей между отломками правильное сопоставление становится невозможным, кость не срастается.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Некорректная репозиция. Отсутствие вправления, недостаточное сопоставление отломков или излишнее растяжение конечности при скелетном вытяжении препятствуют хорошему контакту фрагментов. При запоздалой репозиции оказывается упущенным время наиболее выраженной реакции организма на повреждение.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Неадекватная иммобилизация. Недостаточная, непостоянная или преждевременно прерванная фиксация является причиной нарушений реваскуляризации пораженной зоны, нехватки кислорода и, как следствие, образования хрящевой и соединительной, а не костной ткани.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушения нервной регуляции. При травмах периферических нервов, синдроме Зудека возникают стойкие изменения со стороны сосудов, ухудшающие кровоснабжение пораженной зоны и нередко приводящие к несрастающимся переломам.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нагноение. Локальные гнойные процессы становятся причиной гипоксии и повреждения окружающих интактных тканей продуктами распада. При концевом остеомиелите в зоне контакта отломков образуются участки некроза, которые препятствуют соединению фрагментов.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эпифизарные переломы срастаются лучше диафизарных и метаэпифизарных, поскольку эпифизы лучше кровоснабжаются и в них больше остеобластов. Консолидация ухудшается по мере старения. Образование костной мозоли замедляется при гормональных расстройствах, особенно – сопровождающихся остеопорозом. Отрицательную роль играют дефицит витаминов Д, С и А, наличие заболеваний с нарушениями питания: кахексии, анемии, туберкулеза, злокачественных опухолей. Сращение ухудшается на фоне приема кортикостероидов, НПВС, цитостатиков и антикоагулянтов.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В ходе осмотра оценивают внешний вид конечности, определяют повышение температуры, наличие патологической подвижности и другие симптомы. Измеряют длину парных конечностей и объем движений в суставах. Для более точной оценки тяжести функциональных расстройств пациента просят совершать различные действия: стоять, идти (если это возможно), сидеть, вставать, одеваться и пр. В рамках аппаратного обследования назначают рентгенографию и КТ. По данным визуализационных методик выявляются следующие изменения:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Замедленная консолидация. Визуализируется слабо выраженная периостальная костная мозоль, которая связывает фрагменты и частично перекрывает линию излома. На фоне мозоли прослеживаются участки с отсутствием сращения.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Несросшийся перелом. Острые края отломков сглажены в результате резорбции. Костная мозоль отсутствует или слабо выражена, имеет беспорядочный характер. Линия излома хорошо просматривается на всем протяжении.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ложный сустав. Концы фрагментов утолщены, в их зоне выявляются выраженные склеротические изменения. Костномозговые каналы закрыты замыкательными пластинками.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на местные нарушения кровоснабжения пациентам дополнительно назначают ангиографию, допплерографию или реовазографию. Больным с инфицированными несрастающимися переломами при наличии свищевых ходов производят фистулографию, выполняют забор отделяемого с последующим бактериологическим исследованием для выделения возбудителя и определения антибиотикочувствительности.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Целью лечения несрастающихся переломов является восстановление функции конечности. Основными задачами считаются обеспечение полноценной консолидации, устранение деформации, устранение тугоподвижности суставов, санация инфекционных очагов. При наличии общих провоцирующих факторов (гормонального дисбаланса, авитаминоза и др.) проводят соответствующие общие терапевтические мероприятия. Программу местного лечения составляют с учетом вида несрастающегося перелома.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение замедленной консолидации</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возможна консервативная терапия. Конечность фиксируют с помощью гипсовой повязки или ортеза на срок, необходимый для сращения фрагментов. Для стимуляции консолидации назначают ударно-волновую терапию, УВЧ, электрофорез солей кальция, электромагнитные волны. Применяют анаболические стероиды. В несрастающийся перелом вводят костно-хрящевой экстракт, изготовленный из эмбриональной ткани.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Плюсами консервативной терапии являются отсутствие дополнительной травматизации, наркозных и послеоперационных рисков. Минусами – продолжительная фиксация, которая может обернуться тугоподвижностью суставов и атрофией конечности. Для предупреждения перечисленных осложнений или при отсутствии эффекта от консервативных мероприятий прибегают к оперативному лечению. Возможны следующие варианты:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Остеосинтез. Проводится с использованием винтов, компрессионных пластин, внутрикостных штифтов и аппаратов внешней фиксации. Показан при наличии элементов сращения, отсутствии выраженного смещения и нарушения оси конечности.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Костная пластика. Используют аутотрансплантаты, которые, как правило, берут из крыла подвздошной кости пациента. Перемещенная губчатая кость способствует перестройке окружающей мозоли в нормальную костную ткань.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Стимуляция остеогенеза. Осуществляется с использованием биологических методик – декортикации и туннелизации. При декортикации с помощью острого остеотома вокруг перелома создают муфту из большого количества костных фрагментов, соединенных с надкостницей. При туннелизации формируют туннели, активизирующие костеобразование.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перечисленные методы могут сочетаться между собой в различных вариациях. При обнаружении интерпозиции фрагменты разъединяют, мешающие сращению мягкие ткани удаляют. Деформации устраняют с помощью аппарата Илизарова. После операции применяют консервативные методики для стимуляции остеогенеза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение несросшихся переломов</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Безоперационные способы неэффективны, показана оперативная коррекция. При наличии противопоказаний к хирургическому лечению пациентам с несрастающимися переломами рекомендуют ношение ортезов. Вмешательства включают удаление рубцов и измененных тканей в зоне повреждения, обнажение фрагментов с последующей обработкой концов, сопоставление отломков, биологическую стимуляцию костеобразования. Фиксацию в большинстве случаев осуществляют аппаратом Илизарова.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Попеременное сдавление и растяжение фрагментов в компрессионно-дистракционном аппарате дополнительно активизирует образование сосудов и замещение фиброзно-хрящевой мозоли нормальной костью. При значимых костных дефектах осуществляют аутопластику (например, недостающий фрагмент большеберцовой кости заменяют частью малоберцовой). В послеоперационном периоде назначают стимулирующие методики, проводят комплексную реабилитацию.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение ложных суставов описано в соответствующей статье.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика несрастающихся переломов включает раннюю адекватную репозицию, устранение интерпозиции, отказ от удаления жизнеспособных костных фрагментов, своевременное проведение операций при неэффективности вправления, соблюдение сроков иммобилизации, постепенное увеличение нагрузки на конечность с учетом клинических и рентгенологических признаков сращения.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В покое болевой синдром выражен незначительно или отсутствует. Основной жалобой является ухудшение функции конечности из-за подвижности и болей при движениях. Рука или нога постепенно «усыхают» из-за атрофии мышц. В зоне несрастающегося перелома появляется угловая деформация, которая прогрессирует из-за нагрузки. При замедленном сращении обнаруживается умеренный или нерезко выраженный отек, возможна гиперемия.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При несросшихся переломах и ложных суставах отечность исчезает, выявляется локальное утолщение, обусловленное образованием крупной, но неполноценной мозоли из хрящевой и фиброзной ткани. Гиперемия часто сменяется усиленной пигментацией. Из-за трофических нарушений кожа становится сухой, бледной, приобретает мраморную окраску, шелушится. Могут образовываться трещины, язвы, келоидные рубцы.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Больная конечность тоньше здоровой, ее ось нарушена из-за деформации, возможно укорочение. При пальпации и постукивании определяется нерезко выраженная локальная болезненность. Местная температура при замедленной консолидации и несросшихся переломах повышена, при ложных суставах не изменена. Обнаруживается патологическая подвижность пружинящего характера при отсутствии крепитации. Объем движений в суставах снижен. Опороспособность нарушена.</span></p>",
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"lead": "недостаточная минерализация костной ткани, следствием чего является снижение ее плотности с одновременным увеличением объема",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В основе остеомаляции заложен недостаток в организме витамина Д. Кроме того к дефекту процесса костной минерализации приводят также оперативные вмешательства на желудке и кишечнике, хронические заболевания поджелудочной железы и печени, муковисцидоз.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Минерализация костной ткани - это процесс насыщения костью кальцием и фосфором. Для того, чтобы этот процесс происходил эффективно, требуется достаточный уровень кальция и фосфатов во внеклеточной жидкости и хорошая активность щелочной фосфатазы. Если есть нарушения в одном или в ряде необходимых факторов для минерализации костей, развивается остеомаляция. Содержание кальция в организме напрямую связано с его всасыванием стенками кишечника, а также повторным всасыванием кальция и фосфора в почках.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от того, какое звено фосфорно-кальциевого гомеостаза нарушается раньше, выделяют кальципеническую и фосфопеническую формы остеомаляции.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">К наиболее частым причинам фосфопенической формы остеомаляции относят снижение уровня фосфора в крови вследствие недостатка витамина Д и вторичный гиперпаратиреоз, развивающийся на фоне патологии почечных канальцев с потерей фосфора. Недостаток фосфора в употребляемых в пищу продуктах, воздействие токсинов также могут стать причиной недостаточной минерализации костной ткани.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушение кальциевого обмена чаще бывает приобретенным, и связано оно прежде всего с нарушенным метаболизмом витамина Д, обусловленным заболеваниями печени, оперативными вмешательствами на желудке и кишечнике, болезнью Крона, хроническим панкреатитом и холециститом.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Кроме того, при хроническом почечном канальцевом ацидозе нарушается нейтральная среда в зонах кальцификации, что также приводит к костным дефектам. Качество кальцинирования костей может снижаться при замедленной или недостаточной минерализации, возникающей из-за влияния факторов внешней среды, а именно недостатка инсоляции, злоупотребление вегетарианством, загрязнение окружающей среды тяжелыми металлами и алюминием, прием определенных лекарственных препаратов (бисфосфонаты, фториды).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Изредка причиной остеомаляции может служить наличие такого заболевания как гипофосфотазия, при котором отмечается низкая активность щелочной фосфатазы в крови и связанное с этим замедление минерализации костей.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В костях человека параллельно происходят два процесса: разрушение старой костной ткани и образование новой в сочетании с ее минерализацией. В норме эти процессы сбалансированы, поэтому кости сохраняют свою прочность. При остеомаляции вместо полноценной костной ткани образуется неминерализованный или слабо минерализованный (содержащий мало фосфатов и кальция) остеоид, представляющий собой скопление коллагеновых волокон (основу кости, белковый матрикс), которые придают костям упругость. Из-за нарушения процессов образования новой костной ткани страдает и процесс разрушения старой кости, вследствие чего строение костей еще больше нарушается, а их прочность – снижается.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Минерализация кости зависит от содержания в крови фосфатов и кальция. В зависимости от недостатка того или иного элемента различают две формы остеомаляции: кальципеническую и фосфоропеническую. Недостаток кальция может наблюдаться при нарушении всасывания кальция в кишечнике, дисбалансе между процессом отложения кальция в костях и его выведением из разрушающейся костной ткани, недостатке витамина Д и чрезмерной экскреции кальция почками. Причиной кальципенической формы остеомаляции являются врожденные и приобретенные нарушения синтеза витамина Д вследствие генетических нарушений, цирроза печени, заболеваний желудочно-кишечного тракта, недостаточной инсоляции, продолжительного приема противосудорожных препаратов и вегетарианской диеты.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Количество фосфатов в крови определяется их всасыванием в кишечнике и скоростью выведения в почках. Фосфоропеническая форма остеомаляции возникает вследствие гиперфункции паращитовидных желез (гиперпаратиреоза), недостатка фосфатов в пище и усиленной секреции фосфатов почками при некоторых опухолях, наследственных нарушениях обмена веществ, болезнях почек и т. д. В период беременности и лактации риск развития остеомаляции увеличивается, поскольку потребность организма в витамине Д возрастает, а нагрузка на почки повышается, что может приводить к манифестации различных заболеваний и проявлению ранее латентно протекавших аномалий развития.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз остеомаляция выставляется с учетом рентгенологической картины, клинических симптомов и данных дополнительных исследований. На начальных стадиях на рентгеновских снимках выявляется распространенный остеопороз. В последующем определяется пластическая дугообразная деформация, более заметная на рентгенограммах бедер и голеней, подвергающихся значительным осевым нагрузкам. В местах скопления остеоида становятся видны зоны просветления. При скоплении остеоида в поднадкостничной зоне контуры кости становятся нечеткими, корковый слой – слоистым. При длительном течении остеомаляции и выраженном остеопорозе корковый слой истончается, костномозговое пространство расширяется.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На ранних стадиях остеомаляцию дифференцируют с системным остеопорозом. Для этого осуществляют гамма-фотоновую абсорбциометрию (исследование, позволяющее определить количество кальция и фосфатов на определенном участке кости) или выполняют биопсию костей таза. При исключении опухолевых, воспалительных и системных заболеваний скелета используют данные рентгенографии, а также учитывают характерную локализацию патологических изменений (поражение трубчатых костей у молодых, костей таза – у беременных женщин, позвоночника – у пожилых). При дифференцировке остеомаляции с болезнью Реклингхаузена принимают во внимание отсутствие зон перестройки Лоозера, с поздним рахитом – отсутствие признаков нарушения энхондрального окостенения.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основной задачей при лечении остеомаляции является устранение недостатка витамина Д, соединений фосфора и кальция, что в свою очередь поможет снизить поражение костей, нормализовать скорость их роста и исправить уже возникшие деформации. Эффективным при лечении остеомаляции любой формы считают назначение внутримышечно или внутрь витамина Д, особенно его активных метаболитов и аналоги - альфакальцидола или кальцитриол. Дозировка препарата подбирается индивидуально с учетом данных лабораторных исследований по содержанию фосфатов и кальция в крови, а также зависит от причины, обусловившей развитие остеомаляцию. Для коррекции нарушения всасывания кальция в желудочно-кишечном тракте или в почечных канальцах назначают инфузионные вливания препаратов кальция.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение остеомаляции проводят на протяжении всей жизни больного, однако, дозировка препарата постоянно корректируется в сторону понижения. Специалисты рекомендуют дополнительно назначать витамины группы В и С, которые усиливают активность метаболитов витамина Д.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме того, в рационе больных с остеомаляцией необходимо предусмотреть включение продуктов, содержащих достаточное количество кальция и фосфора. Поэтому в повседневном меню обязательно должно быть включено молоко и молочные продукты (кефир, ряженка, сыр, творог). Помимо этого необходимо включение в рацион сбалансированного количества овощей, фруктов, мяса и рыбы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если консервативное лечение, проводимое на протяжении 1.5-2 лет, не восстанавливает нарушенный процесс минерализации, прибегают к оперативному лечению костных деформаций. Причем в постоперационном периоде следует продолжить прием медикаментов, в частности заместительной терапии витамином Д, во избежание рецидивов переломов костей, образования ложных суставов и других костных деформаций.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В подавляющем большинстве случаев при коррекции заболевания метаболитами витамина Д, препаратами кальция, витамина С и группы В достигается стойкий терапевтический эффект.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-cc03ef98-7fff-f321-ac45-f587f3316ac3\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Профилактика включает своевременное выявление и лечение заболеваний, которые могут стать причиной развития патологии.</span></span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исходя из клинической картины, различают две формы остеомаляции - бессимптомную и манифестную. Бессимптомная форма остеомаляции характеризуется отсутствием очевидных признаков и жалоб больных, а нарушения в костной ткани выявляются при рентгенологическом исследовании.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для манифестной формы остеомаляции характерны жалобы пациентов на мышечную слабость и боли в костях, а объективно можно выявить болезненность при пальпации в зонах проекций костей. Наиболее распространенная локализация болей - область пяток, таза, пояснично-крестцовая область, бедра, голень, ребра. Болевые ощущения усиливаются при движении, поднятии тяжестей и других физических нагрузках. Из-за того, что объем костного матрикса увеличивается или полностью замещает полноценную костную ткань, её прочностные характеристики снижаются, отмечаются деформации, растяжения и даже надрывы надкостницы, которые сопровождаются болевым ощущением постоянного или реже преходящего характера. При таком состоянии костной ткани небольшое физическое напряжение, а порой и ходьба могут стать причиной перелома.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мышечная слабость, характерная для остеомаляции, также обусловлена дефицитом кальция и фосфора, принимающих участие в передаче нервно-мышечных импульсов. Из-за мышечной гипотонии и атрофии, а также выраженных болевых ощущений, изменяется походка больного - при ходьбе он раскачивается из стороны в сторону (\"утиная\" походка).</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Снижение механической прочности костной ткани приводит к развитию деформаций костей, таких как искривления позвоночника, деформации грудной клетки и таза, усугубляющихся наличием многократных одиночных или множественных переломов, которые чаще всего поражают только надкостницу, срастаются на протяжении длительного времени и поражают обычно шейки бедренных костей, большеберцовые, тазовые кости, кости запястья, плюсны и др.</span></p>",
"image": null,
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"danger": 11,
"published": 1,
"parent": null,
"block_rubric": 143,
"standards": []
},
{
"id": 12663,
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"complications": [],
"medicine_branches": [],
"who": [
{
"id": 12506,
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{
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{
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{
"name": "Боль в костях ног"
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{
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"name": "Спина внизу болит"
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{
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"periodicity": 3,
"slug": "m81.9_osteoporoz_neutochnennyy",
"lead": "заболевание скелета с изменением структуры костей: снижением массы, уменьшением прочности и повышением хрупкости",
"description": "<p>Остеопороз - это <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хроническое заболевание костей скелета, которое связано с нарушением обмена веществ, проявляется прогрессирующим снижением плотности и нарушением структуры костной ткани и приводит к переломами при минимальной травме</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патология относится к категории полиэтиологических. Наиболее распространенной причиной первичного остеопороза является возрастная перестройка костной ткани. Реже первичная форма заболевания носит наследственный характер либо возникает по неизвестным причинам. Предрасполагающими факторами остеопороза являются:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">семейный анамнез (указания на переломы, происходившие у пожилых членов семьи в результате небольшой травмы);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пожилой и старческий возраст;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">астеническое телосложение, снижение массы тела;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">небольшой рост;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">позднее начало менструаций (в возрасте 15 лет и старше);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">раннее наступление менопаузы (до 50 лет);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">бесплодие;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушение менструального цикла;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">большое количество беременностей и родов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">длительное кормление грудью.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Поскольку состояние костной ткани зависит от продукции эстрогенов, частота остеопороза резко возрастает в постменопаузальном периоде. Женщины 50-55 лет страдают от переломов вследствие остеопороза в 4-7 раз чаще мужчин. К 70 годам переломы возникают у каждой второй женщины.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вторичный системный остеопороз обусловлен эндокринными нарушениями, соматическими патологиями, образом жизни пациента. Факторами риска развития вторичной формы заболевания считаются:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения деятельности внутренних органов, в том числе – расстройства питания и деятельности желез внутренней секреции, болезни почек, некоторые аутоиммунные патологии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прием некоторых лекарственных средств, злоупотребление никотином, алкоголем и кофе;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">малоподвижность, недостаточные физические нагрузки, длительный постельный режим (при травмах, операциях, хронических патологиях).</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вторичный локальный остеопороз формируется на фоне заболеваний и патологических состояний, сопровождающихся нарушениями костной структуры. Возможными причинами являются:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">травматические повреждения при наличии длительной иммобилизации, нейротрофических расстройств;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">воспалительные процессы, например, остеомиелит;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">первичные злокачественные опухоли костей, костные метастазы новообразований других локализаций.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Единый механизм развития остеопороза отсутствует, поскольку динамика изменения строения и состава костной ткани определяется провоцирующим заболеванием (при вторичном остеопорозе) и наличием различных факторов риска (при первичном процессе). При этом выделяют ряд последовательных стадий, которые наблюдаются при всех видах патологии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Формирование костной ткани нарушается во время роста либо в процессе обновления. Разрушение кости начинает преобладать над ее восстановлением. Плотность, масса кости снижаются. Уменьшается толщина кортикального слоя, количество трабекул. В результате при остеопорозе страдают прочностные характеристики кости, у детей возникают деформации, у взрослых – переломы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Риск возникновения переломов увеличивается пропорционально снижению плотности костной ткани. При снижении плотности костей на 10% частота переломов возрастает в 2-3 раза. Остеопороз в первую очередь поражает кости с преобладанием губчатого вещества (позвонки, кости предплечья в области лучезапястного сустава), поэтому типичными осложнениями заболевания являются переломы тел позвонков, дистального эпифиза лучевой кости.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для диагностики остеопороза применяются следующие методики:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Опрос, осмотр. Во время опроса врач выясняет продолжительность существования и динамику развития симптомов, обращает внимание на характерные анамнестические признаки (длительные боли, частые переломы). При объективном обследовании специалист выявляет нарушения осанки, при подозрении на генетически обусловленный остеопороз определяет признаки того или иного заболевания.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Денситометрия. Позволяет оценить минеральную плотность кости (МПК). Точность измерения при проведении двойной рентгеновской абсорбциометрии составляет 2%. Для определения плотности костей также используют однофотонную (не всегда информативна) и двухфотонную денситометрию, количественную КТ позвоночника. Для скрининговых исследований применяют менее точную ультразвуковую денситометрию.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рентгенологические методы. Малоинформативны в диагностике заболевания, позволяют достоверно выявить признаки остеопороза только при значительной потере массы костных тканей (более 30%). Назначаются для обнаружения свежих переломов, а также костных мозолей и посттравматических деформаций, свидетельствующих о нарушении целостности костей в анамнезе.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторные анализы. Проводятся тесты для оценки уровня фосфора, кальция, витамина Д и паратиреоидного гормона в крови, суточной потери фосфора и кальция с мочой. При возможном вторичном остеопорозе могут выполняться исследования гормонов щитовидной железы, тестостерона, печеночных маркеров.</span></p>\r\n</li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-ece0e993-7fff-f9bc-44c6-42cdf2f99c7c\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Немедикаментозная терапия остеопороза:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">1. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ходьба и физические упражнения (упражнения с нагрузкой весом тела, силовые упражнения и тренировка равновесия)</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">2. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Прыжки и бег противопоказаны</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">3. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отказ от курения и злоупотребления алкоголем</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">4. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ношение жестких и полужестких корсетов для снижения выраженности боли после перелома позвонка (не более 6 часов за день). </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">5. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постоянное ношение протекторов бедра пациентами, имеющими высокий риск развития перелома шейки бедра и факторы риска падений.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">6. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возможно применение кифопластики и вертебропластики для уменьшения болевого синдрома, коррекции осанки у пациентов с переломом позвонка и хронической болью в спине.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">7. </span><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мануальная терапия при остеопорозе противопоказана.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозная терапия:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Препараты кальция и витамина D: Лечение любым препаратом патогенетического действия должно сопровождаться назначением адекватных доз кальция (1000-1200 мг/сутки с учетом продуктов питания) и витамина D до 2000 МЕ в сутки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патогенетические препараты:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">1. Препараты, которые останавливают разрушение костной ткани:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">- бифосфонаты (длительность лечения от 3 х до 5 ти лет. Иногда свыше 5 ти лет.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">- Деносумаб (продолжительность лечения до 10 ти лет).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">2. Препарат, который стимулирует костеобразование:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- Терипаратид (продолжительность лечения до 2 х лет).</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Укрепления костной ткани в детском и подростковом возрасте может быть лучшей защитой от развития остеопороза в старшем возрасте. Рекомендации по профилактике остеопороза следующие:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Придерживайтесь сбалансированной диеты, богатой кальцием и витамином D.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выполняйте физические упражнения</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вести здоровый образ жизни, не курить и не злоупотреблять алкоголем.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принимать лекарства для улучшения плотности костной ткани по мере необходимости.</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Остеопороз называют «безмолвной эпидемией». Это значит, что если у пациента не случился перелом, то симптомы отсутствуют. При переломах они могут быть разными:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хроническая или впервые возникшая боль в спине (следует напомнить, что боль в спине может быть и в ряде других заболеваний и патологических состояний, кроме остеопороза),</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">уменьшение роста на 2 см и более за 1-3 года или на 4 см и более по сравнению с ростом в 25 лет (отражает снижение высоты позвонков при компрессии),</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">расстояние между затылком и стеной более 5 см (отражает наличие грудного кифоза), </span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">расстояние между нижними ребрами и крылом подвздошной кости составляет ширину 2 х пальцев и менее (отражает укорочение позвоночного ствола из-за компрессий позвонков).</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие симптомы остеопороза проявляются, как правило, уже после множественных компрессионных переломов в телах позвонков. Они включают в себя следующие проявления:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выступающий вперёд живот;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рефлюксная болезнь (боли за грудиной, изжога);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">раннее насыщение при еде;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение веса;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ограничение движений;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #181d21; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли в спине и тазобедренных суставах;</span></p>\r\n</li>\r\n</ul>",
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}
]
}
